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KNDU: MBBS for the rich, crumbs for the poor

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By RAMYA KUMAR

A regular day at work. A medical student, Niluka (not her real name), comes to my office to discuss the presentation she is due to make at a research symposium. In the middle of our meeting she is in tears. Her mother, a single mother, who works as a security guard in remote Polonnaruwa, cannot afford her boarding fees as she has to cover her sister’s A/L tuition classes, as well as her brother’s medicines for a recent health issue. Niluka is unable to focus on her presentation because she is worried about her financial situation. She has a year and half to go.

This is the picture of Free Education that many do not see, of students struggling to make ends meet. Such stories are commonplace at our non-fee levying state universities; as Sumathy Sivamohan wrote recently, “free education does not serve everybody equally, but over the years and across decades, it has come to represent the hope of a vast majority for a better place in society.” However, this aspect of Free Education is obscured by images of protesting students “wasting tax-payers’ money,” constructed by the media in the service of the state. While Colombo-based elites (and others) may be duped into seeing the Kotelawala National Defence University (KNDU) Bill and military repression as solutions to the problems in higher education, this article explores what the Bill really means, especially its implications for medical education.

No vision, no imagination

Free Education, despite its marginalisations and exclusions, is etched in our nation’s consciousness, so much so that governments have been reluctant to overtly dismantle the public education system. Instead, they have stealthily underfunded the system, while incentivising expansion of private education. With inadequate public investment, the state universities under the UGC are floundering to service demand, while the fee-levying Kotelawala Defence University (KDU) and non-state fee-levying higher educational institutions, such as SLIIT, receive state subsidies to finance infrastructure as well as student loans.

Fee-levying universities are simply not affordable for the vast majority in this country. To flourish, they require public-financing, both for their establishment and for student loans, to make them accessible to the masses. While escalating investment in KDU and private fee-levying universities through public funds, the government has adopted a zero-investment policy for state universities under the UGC and increased admissions by a third, this year. The fallout of increasing admissions without budgetary allocations is most felt by universities in peripheral districts, already running on meagre resources.

A government’s vision for education is inextricably linked with its economic policy. While lacking a credible vision for education, successive governments have been equally unimaginative in attempts to improve the economy. Sri Lanka relies on imports for day-to-day essentials, such as lentils, pulses, and milk, with little investment in agriculture or agro-industries for value addition. Meanwhile, billions of rupees are lost in tax incentives to attract (elusive) foreign direct investment, including in education. The Board of Investment expanded its purview to include the social sector in the 1990s, essentially opening education to the global market. The latter has changed the landscape of education in the country with international schools, private colleges and other higher education institutions proliferating in the decades since, and creating parallel systems of education for students from rich and poor families.

Enter KNDU

Faced by mounting debt, the government is desperately looking for avenues to build up its foreign reserves. In 2019, the incumbent government proposed a “free education investment zone” to attract investment from “top international universities,” with accompanying tax exemptions, yet another scheme to subsidise the private sector through public funding. With COVID-19, the plans for the investment zone fell by the wayside. However, just a few years after the SAITM debacle, the government is once again looking to expand private medical education, this time through the KDU.

In 2019, the incumbent President’s manifesto, which is the government’s policy framework, stated that “steps will be taken to expand the Kotelawala Defence University” (p.22). Why KDU? Because the majority of its students are enrolled on a fee-levying basis through mechanisms outside the UGC’s Z score-based system. Although seemingly catering to the military, a closer look at the statistics presented on the website of KDU’s Faculty of Medicine, indicate that the number of medical students recruited doubled, and then tripled, once the faculty began to enroll “non-military foreign students.” As recruitment was limited to foreign students, albeit loosely defined, KDU did not encounter too much controversy.

The KNDU Bill proposes to build a parallel militarised university system, and alternatively, a change to the Universities Act of 1978 aims to bring KDU under the purview of the UGC, as a university for a “specific purpose.” Clearly, the appeal of KDU and other “specific purpose” universities is not their potential to strengthen Free Education. That these reforms will increase the military’s involvement in higher education has been the focus of debate in recent weeks, but less attention has been paid to their implications for education opportunities for students like Niluka, and their potential impact on medical education.

‘MBBS Kada’

Both the proposed KNDU Bill and the amendment to the Universities Act can be viewed as attempts to create the conditions for the expansion of fee-levying MBBS degree programmes, which have been resisted since the days of NCMC. The KNDU Bill will give legal authority for KNDU to recognise and affiliate other institutions to KNDU, bypassing the UGC as well as the Sri Lanka Medical Council’s minimum standards. The Bill will ultimately result in the proliferation of poorly regulated ‘MBBS kada,’ and a decline in the overall standards of medical education.

Even the Association of Medical Specialists (AMS), a body not averse to private education, has made the following statement regarding the KNDU Bill: “On principle, the AMS is not against quality fee levying medical education…if it is regulated and monitored by the UGC and the Sri Lanka Medical Council. However, lack of proper process and transparency will prevent the establishment of such fee levying institutions in Sri Lanka.”

Could expanding medical education in this manner present opportunities to address problems in the health sector, such as the regional maldistribution of physicians?

First, if KNDU and its affiliates aim to attract international medical students, it is unlikely that these graduates would serve in Sri Lanka.

Second, as the Bill will enable KNDU to admit local students, if we assume the current fee structure of upwards of Rs. 1 million per year for the MBBS programme, the KNDU medical students would represent the elite who are more likely to immigrate to greener pastures.

Third, if the government intends to broad-base MBBS degree programmes, they would need to offer hefty student loans to our students. Evidence from other countries suggests that medical graduates with student loans are more likely to opt for higher paying specialties rather than work in primary care, and less likely to serve in rural areas.

It is therefore unlikely that the KNDU Bill would contribute towards advancing the health sector, except perhaps through its military cadets, who would most likely work for the Ministry of Defence and not the Ministry of Health.

Student loans may have other unintended consequences. Despite private practice being widespread, many doctors, especially women non-specialist doctors, do not engage in private practice. In fact, general doctors from peripheral districts often do return to their districts, although they may remain in urban centres owing to the poor education facilities available to children in remote rural areas. These doctors make up the physician workforce in base hospitals and above, as well as in the preventive sector, in all parts of the country. Having to repay a student loan may drive such doctors to remain in districts, where private practice is more available and lucrative, intensifying the regional maldistribution of physicians.

Crumbs for the poor

What of students like Niluka in the non-fee levying state university system? A quick perusal of the website of KDU’s Faculty of Medicine indicates that brain drain may have already commenced. Imagine the fate of our non-fee levying state medical faculties with the mushrooming of ‘MBBS kada’ across the country? They will inevitably offer higher salaries, as does KDU, attracting without any outlay teachers whose training was subsidised by state universities. Furthermore, as reported in the media, KDU has already seen massive state investment, much of it in its teaching hospital, far beyond investments in any single university or faculty of medicine under the UGC. The fate of medical education at non-fee levying state universities does not need to be spelled out here. With their weakening, the demographics of students who enter medicine are sure to change, with fewer and fewer opportunities for students like Niluka, not to mention the broader implications for medical education and the healthcare system.

Let’s stand together to protect Free Education and Free Medical Education!

 

(The writer is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna).



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Opinion

A paradox of history

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Shakespeare

There seems to be a striking similarity between ancient Greece and modern Britain. Both countries remain paradoxes of history. Greece was a small city state constantly at war with neighbouring countries. It did not have a big army, but it had considerable sea power. However, Greece was a leading state over the whole of the Mediterranean. In fact, Greece was once a super power in the Western world.

Britain was very powerful in the 19th century. British justice was administered in Africa, India and Ceylon. British factories flourished in many countries and schoolchildren started reading R.L. Stevenson’s ‘Treasure Island’ and the works of Rudyard Kipling. What Ralph Waldo Emerson said in the 1850s is still valid today. He said, “If there’s one test of national genius universally accepted, it is success; and if there be one successful country in the universe for the last millennium, that country is England. It is the best of actual nations.”

In World War I, Britain faced a crushing defeat. Eventually, the British Empire was reduced to a Commonwealth. World War II shattered the image of Britain further. Although Britain lost much of its power, it continued to be an influential country. Even after achieving independence, India retained English as an official language. The British parliament system is well established in many Commonwealth countries. Some people still wonder how England still exercises its influence over the minds of men and women.

Staying power

There are many powerful countries in the world today such as the United States, Russia and China. Although England is not a super power, she has staying power. According to Oliver Wendell Holmes, a good part of greatness is simply being there. For that matter, England has been there for many centuries. So far no other country has been able to defeat her. As a result, sometimes we wonder whether we can have a world without England.

England has had an unwritten Constitution for a very long time. Other countries have emulated her political institutions. The British people have an established church with complete religious freedom. Although there are social classes in Britain, there has been no major clash among them. Unlike in many other countries, there are only two leading political parties in England. When the Labour Party is in power, the government is not subservient to labour. Similarly, when the Conservative Party is in power, the government is not conservative.

Most British colonies in the East including India and Ceylon did not sever the cultural and emotional links with Britain and retain them even after achieving independence. India became independent in 1947, but she decided to retain English as an official language. By doing so, India produced a number of English writers such as R.K Narayan. However, Ceylon did not give English any official status and treated it as a link language. As a result, students paid less attention to learning English. They were made to understand that everything can be done by learning Sinhala and Tamil. We have failed to produce English writers in the calibre of J. Vijayatunga who wrote ‘Grass for my feet.’

Politically shrinking

The United Kingdom is politically shrinking. However, its influence vibrates throughout the world. English has brought many nations together. There is a common understanding among countries that share the English language and literature. William Shakespeare’s dramas are staged in countries such as China where English is not an official language. People have come to the conclusion that English has become a broker of ideas and institutions.

England is not an aggressive country. However, if provoked, it can deliver a mortal blow to its enemy. British Prime Minister Margaret Thatcher showed her mettle as the iron lady. Britain held the fort against the might of Napoleon Bonaparte who ruled France. The country can still boast of a heavy moral credit. The British stick to their international agreements. The power of England draws mainly from its language. British people say ‘It’s right’ when it is right’. When it is not right, they say, ‘It’s not right.’ Meanwhile English occupies a pre-eminent place in world languages. All the research work in many parts of the world is available in English. You can learn any subject easily through English.

Apart from the language, people respect British standards which are technical specifications and quality benchmarks developed by the British Standards Institution. The United Kingdom’s independent national standards body was established in 1901. It maintains over 37,000 standards covering industries such as construction, manufacturing and technology ensuring safety and reliability.

British English

Standard British English is the variety of English that has undergone codification to the point of being socially perceived as the standard language associated with formal schooling, language assessment and official print publications. For historical reasons dating back to the rise of London in the ninth century, the form of language spoken in London and the East Midlands became the Standard English used in schools, universities, literature and law.

British English functions as one of the two major foundational and standard varieties of the English language alongside American English. It serves as a primary reference point for spelling and grammar. It acts as a global standard, and international institutions are often defined by specific pronunciation.

Most Sri Lankan doctors primarily move to England for postgraduate training, higher specialisation and better career prospects. They are driven by superior training infrastructure, world-class facilities and globally recognised qualifications.

To sum up, when you think of learning an international language, there is no alternative to English. If you wish to read literature, you cannot ignore eminent English dramatists and poets such as William Shakespeare and John Milton. Many leading Sri Lankans like S.W.R.D. Bandaranaike were Oxford University products. Therefore, English deserves to be made an official language in Sri Lanka.

karunaratners@gmail.com

By R.S. Karunaratne

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Opinion

State Literary Awards only for the rich?

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The Department of Cultural Affairs has once again called authors, and publishers to lodge their entries for selection of the prestigious State Literary Awards 2026.The criteria and conditions required and notified in the public domain, makes it mandatory for the literary work to be printed and published prior to submission for consideration of the awards. There is absolutely no provision for writers to submit their work in Manuscript form.

Where does that leave the financially impoverished writers who are talented, creative and wish to submit a well edited typescript of their work as manuscript for consideration of the State Literary Awards? In a literary environment that encourages a proliferation of self-published books of all forms and features presented by vanity publishers who have their eye on the purse of the author than on literary merit and artistic excellence, it is easy to show that you are an ” established writer” by spending your cash abundantly towards glossy covered books which the printing industry and fawning publishers will lap up with greed.

Even the Gratiaen Prize in Sri Lanka, sponsored by world-renowned Michael Ondaatje allows for Manuscript entries together with published books. Significantly, the manuscript entries that win the prize are assisted to publish their work which is part of the winnings. Many a young, aspiring writer with little funds who won the Gratiaen Prize on merit, but had submitted their entry in manuscript form have been thereby encouraged to submit their work on merit basis only.

It is a fact that the Commonwealth Short Story Prize, a massive state-supported initiative across 56 nations accepts only unpublished short fiction. Further, several countries in the world have established national or state level literary prizes that specifically accept unpublished manuscripts to provide equity in discovering new talent and supporting national literature without bias or favour. In Australia, Jamaica, Philippines, major national awards organised by the State for literature, specifically accept unpublished manuscripts for consideration.

Let’s face the truth. The printing costs are escalating. There is little demand in Sri Lanka for literary work in the English Language in particular. Traditional Publishing where the literary work is reviewed and assessed for talent and creativity and thereafter published is seldom found. The reviews and critical analysis of literary works are rare. But publishers make a pile by pandering to the vanity of aspiring writers who have the financial clout to pay their way through to being featured in prestigious award ceremonies and accolades. Thereafter, their substandard works get a further fillip by bearing the label of “Won the State Literary Award for Literature”! It is a cycle of literary charlatans and their pimps in the publishing industry for whom the price that is paid for publishing and not Meritocracy is the sine-qua-non.

Is this the level playing field promised by the NPP Government and their Marxist protagonists? A government that was voted into power on the platform of affording fair opportunity and equality seems to discriminate in favour of the Haves against the Have- nots in the cultural department to say the least! Anil Fernando

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Opinion

Delivering on English

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English literature offers a rich heritage of wonderful ideas and thoughts. The reader can be intellectually uplifted. It brings refreshing new vistas and stimulating new ideas. However, this English literature has to be first introduced to the student in order to fire up his or her interest and be made aware of this rich source of culture. Students of basic English as a second language work hard and learn all the hum-drum mechanics of the language, for which they get tested and graded. But importantly, nae crucially, this should be followed up with intellectual rewards for the students’ efforts – which, of course, is the enjoyment of the works of literature of the many great writers in the English language. This is the great payoff, the great dividend for all their efforts but this, apparently goes missing.

One of the obvious reasons for the lack of “follow through” may be lack of time allocated in the curriculum – or, perhaps, more darkly, the teachers’ own lack of knowledge of the great range of good reading materials produced by the countless generations of literary geniuses who have gone before. Such writers have laid down for us a heritage of glorious literary works in books and essays, all of which are to be found in any good library. It is thought that much of this good literature ought to be introduced to all students of English, “full stop,” as part of developing a knowledgeable and cultured society. (Isn’t that what we want?) Reading English literature should bring an intellectual enrichment to all those willing to drink from this Bacchanalian horn of plenty.

It must be said finally, that it can be fairly expected that most young people, especially those learning English as a second language, are totally unaware of the many outstanding pieces of writing that propel English to stand tall amongst the rest. That is, students need to be first introduced to great writings and have a spark of interest ignited in these great works of literature.

For example, by being introduced to “Daffodils,” a short descriptive poem by William Wordsworth, the student can get some very pleasant ideas to think on.

Do not overlook Conan Doyle’s “Sherlock Holmes” detective stories, each one captivating the reader’s attention right to the end. It is by these short stories that the novice reader can first consolidate his power of reading.

For light reading Jerome K. Jerome’s book “Three Men in a Boat” is suggested. On one occasion he goes to the library suffering from a slight hay-fever (allergy) seeking a cure. He consults a book, “Lexicon of Pharmacology”, and recoils in horror as his symptoms fit most of those diseases described in the book! He concludes he cannot live much longer and staggers home to rest and recuperate! This is a well related tale in the book – although seemingly quite implausible!

Similarly, by having the poem meanings explained, e.g. “What is Life if Full of Care?” by William Henry Davis – how he regrets that we humans are always in a hurry, too busy to notice or see the delights of nature, and scenes of natural beauty, e.g., a young woman’s smile as she passes by; we have no time to make friends and even kiss her. Regrets! Explaining this to students would bring a certain intellectual insight.

John Keats’s poem, “Ode to Autumn” is another great work describing the ripening fruits of the autumn season and how nature as a living being, brings to fruition all the good things of a rural landscape quietly humming with warmth after a hot summer.

Again, it is likely necessary to explain to a young, Sri Lankan mind the meaning of the descriptive poetry found in this magnificent poem.

This is the real English to be tasted and then swigged at lustily in pleasure and satisfaction, not some writing airing historical grievances for children to study!

1970 British Cohort Study

It should be observed here that the ‘1970 British Cohort Study’ followed 70,000 people to examine various aspects of their lives. One result discovered was that if a young person reads a lot, it develops his/ her general intelligence no-matter his parents; it makes him smarter.

It was also noted that reading brings life-long benefits; it improves mood, it helps with social skills, increases empathy, reduces anxiety, protects against depression and slows brain decay, the study found.

But these days many young people never gain a great competence in reading English; the fear is that standards are falling. This is bringing poorer critical thinking, less depth of personality and less empathy for others which has the result of a more turbulent society.

People are urged to switch off their headphones and read more of what they like – try reading the newspapers!

Priyantha Hettige

 

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